1. Field of the Invention
This invention relates to the field of hand-manipulated instruments used for surgical, therapeutic, investigative, and other medical or non-medical applications in any space, specifically to a multi-purpose and minimally invasive instrument having a small diameter elongated rod with a distal end that receives different interchangeable tools one-at-a-time for a variety of uses. An operator uses the scissors-like handle of the instrument, with its fixed arm and its movable arm, to control the tool secured to the distal end of its elongated rod by manipulating the amount and/or polarity of electricity produced by a generator electrically connected between the movable arm and the tool (or other electrically connected device capable of transmitting metered amounts of electricity to the tool). The movable arm is initially placed into a neutral position, wherein operator manipulation of the movable arm can occur in two directions, toward the fixed arm to increase the amount of electricity transmitted to the tool and enhance a first operative effect/function, with operator manipulation of the movable arm away from the fixed arm also increasing the amount of electricity transmitted to the tool, perhaps with opposite polarity, to enhance a different operative effect/function (for example a first operative effect/function might be to close the blades of endoscopic scissors, with the second effect/function being to open the blades of the same endoscopic scissors). Thus, for a tool that opens and closes, operator manipulation of the movable arm away from the fixed arm could be used to open the jaws of the tool, while operator manipulation of the movable arm toward the fixed arm could close the jaws of the same tool. For tools that do not have an opening or closing action, operator manipulation of the movable arm in one direction could cause a first type of therapeutic or investigative effect/function, with operator manipulation of the movable arm in the opposite direction causing a second type of therapeutic or investigative effect/function, such as the alternate execution of cutting and coagulation actions by the same laser probe. It is also contemplated for the amount of movement of the movable arm in either direction away from its initial centrally-located neutral position to correlate to the amount of therapeutic or investigative effect/function achieved. Thus, springs are preferably used to create a biasing effect that permits an operator to sense an increase in resistance as operator-regulated force is increasingly applied, to naturally mimic the resistance that would otherwise be felt during direct manual manipulation of tissue by the tool's operative tip. The biasing springs also make the operator use more force to get the movable arm closer to a position of near maximum displacement (indicated by a plus sign in the accompanying illustrations), which results in the creation of more closure force between the blades at the tip of the interchangeable tool and less closure force between the blades when the operator brings the movable arm back toward its neutral starting position. Stored energy in the biasing spring further assists the operator in bringing the movable arm back to its neutral starting position as the operator-applied force decreases. Thus, when needed for use in a limited-access cavity, the elongated rod of the present invention enters the cavity through a very small diameter telescopic port, which provides the small diameter elongated rod with added support during its use. Interchangeable tools needed for use in the cavity include, but are not limited to, imaging probes, surgical probes, sensor probes, clamping devices, cutting instruments, electromagnets, radio frequency probes, laser probes, laser cutting devices, laser coagulating instruments, heat-generating probes, image sensing probes, ultrasound probes, magnetic resonance imaging probes, and a variety of other devices. Such tools enter the cavity independently from the instrument through a regular-size port opening while being temporarily secured to the pivoting cradle of a tool introducer that is later removed from the regular-size port opening once the tool becomes attached to the distal end of the elongated rod. In its place when the tool introducer is withdrawn, a sheath with a central opening may be inserted through the regular-size port opening to separate the wires or cables extending to different tools present within the cavity and thereby prevent the wires and cables from becoming entangled during tool use. Exit of the tool from the cavity is also accomplished via the cradle of the tool introducer. A bore longitudinally through the tool introducer permits concurrent use of an endoscope/camera in the same regular-size port opening employed by the tool introducer, and thereby precludes the need for an additional patient incision to insert a camera and lighting needed for operator viewing of targeted tissue and assistance in the mounting of a tool on the distal end of the elongated rod. While the same tool introducer can be used to exchange the tools on the same present invention instrument, a single tool introducer can be used to mount, exchange, and/or remove the tools from all of the present invention instruments simultaneously or sequentially used within a cavity to accomplish needed surgical, investigative, and therapeutic procedures. Once the tool introducer is removed, any small diameter electrical wiring or cable used to connect the mounted tool to a source of operative power remains extended through the regular-size port opening, which is also sufficiently large to receive the same or different optical system (endoscope/camera), as well as the small diameter electrical wiring or cable connected to the tools mounted on the elongated rods of any other present invention instruments positioned within the same cavity. As previously mentioned, a sheath can be inserted into the regular-size port opening after all of the tools needed in a cavity are present and the tool introducer is withdrawn, with the sheath being employed to maintain spaced-apart positioning between the optical system and electrical wiring or cables during tool use. Although it is contemplated for the wiring or cable for all present invention instruments used in one cavity to extend through one regular-size port opening, the elongated rod of each present invention instrument employed would individually enter the cavity through its own independent micro opening that is not much bigger than a needle mark and capable of healing with little or no visible scar. Further, as a result of the present invention using a very narrow diameter elongated rod to support a tool (instead of the tube used in prior art surgical, therapeutic, and investigative devices) and also as a result of the present invention having an external means of controlling tool operation that can be carried through the cavity wall via an independent (regular-size) port opening (in contrast to the internal tool control means (i.e. cable/wiring) carried within the tube of prior art surgical, therapeutic, and investigative devices), the present invention can use smaller diameter (micro port) openings (for example, in common intra-abdominal endoscopic surgeries, micro openings with present invention use can be approximately two millimeters in diameter or less) than is possible for prior art devices performing similar functions, with the smaller micro openings being able to heal faster and with little or no visible scar, for improved patient satisfaction. Thus, in summary, an important surgical benefit of the present invention is the potential use of several surgical, investigative, and/or therapeutic tools simultaneously in a cavity with only one very small diameter and fast-healing micro port opening made in the cavity's wall for each minimally-invasive instrument employed, with all of the tools, electrical wiring and cables needed for tool operation, as well as an optical system (endoscope/camera), having their introduction into the cavity (and removal therefrom) being accomplished via a tool introducer with a pivoting cradle that is inserted through a single regular-size port opening, which expedites patient recovery with excellent cosmetic outcome.
2. Description of the Related Art
Although surgical and other medical procedures have undergone much advancement over the years to simplify them, reduce their duration of use, require less manpower, improve cosmetic outcome, and/or lessen the time needed for patient recovery, there still is opportunity for improvement in all of these areas when the procedure requires entry through a cavity wall, particularly relating to reduced patient recovery time and a good cosmetic result. Thus, instead of making one or more lengthy incisions at the beginning of a surgical or other medical procedure to create one large access opening near to the organ or tissue needing surgical assistance, for many surgical procedures it is now common to employ several smaller openings through the skin (each between approximately five and twelve millimeters in diameter), with each such smaller opening configured for the insertion of an instrument that one or more surgeons can use alone or in concert with at least one other instrument (that extends into the cavity through a separate and independent opening) to perform specific investigative and/or therapeutic operations. Even though the use of small openings reduces the risk of infection and produces a cosmetic result better than that achieved by the previous practice of making one or more lengthy surgical incisions, prior art devices still use tubes (instead of rods) to mount the needed probes or therapeutic devices for entry into a cavity, wherein at least a part of the operative controls for mounted devices are carried within the tube, thus limiting the minimum size of the port opening that can be used for entry through a cavity wall (especially large cavities like the intra-abdominal cavity) to approximately five millimeters. Small tubes are also more likely to bend or break than a rod because of their hollow structure, another limiting factor of tube use. While a five millimeter opening in a patient's skin will produce significantly less scar tissue than the lengthy incisions previously used, a five millimeter opening is still sufficiently large to pose an infection risk, and once healed it still remains a visible reminder of the surgery. In contrast, the present invention introduces an elongated rod into a cavity through a much smaller diameter opening (a micro opening typically having a diameter dimension of approximately two millimeters or less), which is similar in size to the opening produced by the tip of a needle and can often heal without any visible scar. Tool control for multiple present invention instruments is accomplished through a single regular-size port opening that is concurrently used by an optical system (endoscope/camera), which is needed to provide operator viewing inside the cavity. Thus, via the use of one or more present invention instruments simultaneously or in sequence to conduct a medical or surgical procedure, there is only one incision mainly at risk for infection and formation of scar tissue, which is the regular-size port opening made for tool and optical system introduction (as the other port openings used are no greater than needle marks that typically heal without scars), thus the cosmetic outcome for a patient is improved and recovery time is also reduced.
The invention thought to be the closest to the present invention is the invention found in U.S. Pat. No. 5,441,059 to Dannan (1995). Although both the Dannan invention and the present invention provide methods of minimally invasive surgery using a larger primary incision for inserting surgical heads/tools and at least one smaller secondary incision for insertion of a receiving end of a handle used by the operator to control an attached surgical head/tool, the present invention has many advantages over the Dannan invention. One important advantage is the present invention's use of a rod as the tool-receiving end of the operator's hand grip, instead of a tubular structure through which power can be sent to the surgical head/tool for its actuation, as in the Dannan invention (column 5, lines 21-28). A rod is less likely to bend or break than a tubular structure, and permits a smaller diameter incision in a patient. As a result, instead of requiring a secondary incision of approximately 2.8 to 3.2 mm (as in the Dannan invention column 4, lines 31-34), the present invention rod can be successfully used with a secondary incision of only 2 mm. Every reduction in incision size is significant and means less infection risk, faster patient recovery, and less scarring. Other important differences between the present invention and the Dannan invention include the present invention's use of a telescoping port assembly for protection and support of its tool-supporting rod (it also allows for rotational movement), a tool introducer inserted through the larger primary incision that has a pivoting cradle and a control knob positioned outside the cavity for operator control of cradle movement to provide facilitated attachment of a tool to the distal tip of its tool-supporting rod, a longitudinally-extending interior laparoscopic bore through the tool introducer that ensures adequate operator viewing of all work performed within a cavity for enhanced safety, an exterior channel on the tool introducer adapted for temporarily containing and protecting electrical wiring or cables attached to a tool during insertion of the cradle through a regular-size port opening in a cavity wall, a beveled outer surface on the tool introducer configured for facilitated release of the electrical wiring and cables from its exterior channel, and a sheath that is usable after all of the tools needed in a cavity are present and the tool introducer has been withdrawn, with the sheath having a central opening configured for insertion of an optical system (endoscope/camera) and a plurality of exterior channels each configured for supporting the wiring/cables attached to one of the inserted tools to maintain the wiring/cables from different tools separate from one another and prevent them from becoming entangled as a result of tool use. At a minimum, the lack of a control knob for selective tilting of the tool introducer cradle for tool attachment from a location outside the cavity, the lack of a longitudinally-extending interior laparoscopic bore through the tool introducer designed to allow the concurrent introduction of an optical system (endoscope/camera) with it through the same cavity port to ensure adequate operator viewing of all work performed within a cavity for enhanced safety, and lack of a supportive entry port means to protect and strengthen the small rod used for tool attachment especially in its lateral movement (side to side movement) in which the rod experiences the highest level of stress to its material (which allows the use of a smaller rod diameter), are significant omissions from the Dannan invention that make it less desirable for use than the present invention. All of the above-mentioned features of the present invention not provided in the Dannan invention, are important as they contribute to the enhanced ease, convenience, safety, and/or expediency of present invention use.
Another distinguishing difference between the present invention and the Dannan invention is the handle grip of the present invention through which the operator can control the action of surgical tools connected to the distal end of an attached rod, wherein first and second biasing springs help to provide metered power to each surgical tool for its control when mounted on the rod's distal end, with the electricity that is manipulated by the handle grip being produced by a generator electrically connected between the movable arm and the mounted tool. The biasing springs also allow an operator to sense an increase in resistance with an increase in operator-applied force that mimics the resistance the operator would otherwise feel during direct manipulation of tissue by the interchangeable tool's operative tip. Such resistance sensing is important to an operator and not provided by the Dannan invention. The present invention also has an arcuate projection of rigid construction positioned between its fixed and movable arms. The arcuate projection acts as a deployment guide for one of its biasing springs, and a portion of the arcuate projection/guide passes through the movable arm of the present invention when an operator applies a force that places the movable arm out of its neutral starting position and causes it to move father away from its fixed arm, or closer to it. This arcuate projection works as an electric current control resistor, where the resistance is at its highest when the movable arm is in the central neutral position. Lack of the arcuate projection in the Dannan invention, in addition to the many other features of the present invention identified above that are not found in the Dannan invention disclosure, distinguish the present invention from Dannan. As a result, no other invention is currently known to have the same structure, or all of the features and benefits provided by the present invention.